[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[S. 641 Enrolled Bill (ENR)]
S.641
One Hundred Fourth Congress
of the
United States of America
AT THE SECOND SESSION
Begun and held at the City of Washington on Wednesday,
the third day of January, one thousand nine hundred and ninety-six
An Act
An Act to amend the Public Health Service Act to revise and extend
programs established pursuant to the Ryan White Comprehensive AIDS
Resources Emergency Act of 1990.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Ryan White CARE Act Amendments of
1996''.
SEC. 2. REFERENCES.
Whenever in this Act an amendment is expressed in terms of an
amendment to a section or other provision, the reference shall be
considered to be made to a section or other provision of the Public
Health Service Act (42 U.S.C. 201 et seq.).
SEC. 3. GENERAL AMENDMENTS.
(a) Program of Grants.--
(1) Number of cases.--Section 2601(a) (42 U.S.C. 300ff-11) is
amended--
(A) by striking ``subject to subsection (b)'' and inserting
``subject to subsections (b) through (d)''; and
(B) by striking ``metropolitan area'' and all that follows
and inserting the following: ``metropolitan area for which
there has been reported to the Director of the Centers for
Disease Control and Prevention a cumulative total of more than
2,000 cases of acquired immune deficiency syndrome for the most
recent period of 5 calendar years for which such data are
available.''.
(2) Other provisions regarding eligibility.--Section 2601 (42
U.S.C. 300ff-11) is amended by adding at the end thereof the
following new subsections:
``(c) Requirements Regarding Population.--
``(1) Number of individuals.--
``(A) In general.--Except as provided in subparagraph (B),
the Secretary may not make a grant under this section for a
metropolitan area unless the area has a population of 500,000
or more individuals.
``(B) Limitation.--Subparagraph (A) does not apply to any
metropolitan area that was an eligible area under this part for
fiscal year 1995 or any prior fiscal year.
``(2) Geographic boundaries.--For purposes of eligibility under
this part, the boundaries of each metropolitan area are the
boundaries that were in effect for the area for fiscal year 1994.
``(d) Continued Status as Eligible Area.--Notwithstanding any other
provision of this section, a metropolitan area that was an eligible
area under this part for fiscal year 1996 is an eligible area for
fiscal year 1997 and each subsequent fiscal year.''.
(3) Conforming amendment regarding definition of eligible
area.--Section 2607(1) (42 U.S.C. 300ff-17(1)) is amended by
striking ``The term'' and all that follows and inserting the
following: ``The term `eligible area' means a metropolitan area
meeting the requirements of section 2601 that are applicable to the
area.''.
(b) Emergency Relief for Areas With Substantial Need for
Services.--
(1) HIV health services planning council.--Subsection (b) of
section 2602 (42 U.S.C. 300ff-12(b)) is amended--
(A) in paragraph (1)--
(i) by striking ``include'' and all that follows
through the end thereof, and inserting ``reflect in its
composition the demographics of the epidemic in the
eligible area involved, with particular consideration given
to disproportionately affected and historically underserved
groups and subpopulations.''; and
(ii) by adding at the end thereof the following new
sentences: ``Nominations for membership on the council
shall be identified through an open process and candidates
shall be selected based on locally delineated and
publicized criteria. Such criteria shall include a
conflict-of-interest standard that is in accordance with
paragraph (5).'';
(B) in paragraph (2), by adding at the end thereof the
following new subparagraph:
``(C) Chairperson.--A planning council may not be chaired
solely by an employee of the grantee.'';
(C) in paragraph (3)--
(i) in subparagraph (A), by striking ``area;'' and
inserting ``area, including how best to meet each such
priority and additional factors that a grantee should
consider in allocating funds under a grant based on the--
``(i) documented needs of the HIV-infected population;
``(ii) cost and outcome effectiveness of proposed
strategies and interventions, to the extent that such data
are reasonably available (either demonstrated or probable);
``(iii) priorities of the HIV-infected communities for
whom the services are intended; and
``(iv) availability of other governmental and
nongovernmental resources;'';
(ii) by striking ``and'' at the end of subparagraph
(B);
(iii) by striking the period at the end of subparagraph
(C) and inserting ``, and at the discretion of the planning
council, assess the effectiveness, either directly or
through contractual arrangements, of the services offered
in meeting the identified needs;''; and
(iv) by adding at the end thereof the following new
subparagraphs:
``(D) participate in the development of the statewide
coordinated statement of need initiated by the State public
health agency responsible for administering grants under part
B; and
``(E) establish methods for obtaining input on community
needs and priorities which may include public meetings,
conducting focus groups, and convening ad-hoc panels.'';
(D) by redesignating paragraphs (2) and (3) as paragraphs
(3) and (4), respectively;
(E) by inserting after paragraph (1), the following new
paragraph:
``(2) Representation.--The HIV health services planning council
shall include representatives of--
``(A) health care providers, including federally qualified
health centers;
``(B) community-based organizations serving affected
populations and AIDS service organizations;
``(C) social service providers;
``(D) mental health and substance abuse providers;
``(E) local public health agencies;
``(F) hospital planning agencies or health care planning
agencies;
``(G) affected communities, including people with HIV
disease or AIDS and historically underserved groups and
subpopulations;
``(H) nonelected community leaders;
``(I) State government (including the State medicaid agency
and the agency administering the program under part B);
``(J) grantees under subpart II of part C;
``(K) grantees under section 2671, or, if none are
operating in the area, representatives of organizations with a
history of serving children, youth, women, and families living
with HIV and operating in the area; and
``(L) grantees under other Federal HIV programs.''; and
(F) by adding at the end thereof the following:
``(5) Conflicts of interest.--
``(A) In general.--The planning council under paragraph (1)
may not be directly involved in the administration of a grant
under section 2601(a). With respect to compliance with the
preceding sentence, the planning council may not designate (or
otherwise be involved in the selection of) particular entities
as recipients of any of the amounts provided in the grant.
``(B) Required agreements.--An individual may serve on the
planning council under paragraph (1) only if the individual
agrees that if the individual has a financial interest in an
entity, if the individual is an employee of a public or private
entity, or if the individual is a member of a public or private
organization, and such entity or organization is seeking
amounts from a grant under section 2601(a), the individual will
not, with respect to the purpose for which the entity seeks
such amounts, participate (directly or in an advisory capacity)
in the process of selecting entities to receive such amounts
for such purpose.
``(6) Grievance procedures.--A planning council under paragraph
(1) shall develop procedures for addressing grievances with respect
to funding under this part, including procedures for submitting
grievances that cannot be resolved to binding arbitration. Such
procedures shall be described in the by-laws of the planning
council and be consistent with the requirements of subsection (c).
``(c) Grievance Procedures.--
``(1) Federal responsibility.--
``(A) Models.--The Secretary shall, through a process that
includes consultations with grantees under this part and public
and private experts in grievance procedures, arbitration, and
mediation, develop model grievance procedures that may be
implemented by the planning council under subsection (b)(1) and
grantees under this part. Such model procedures shall describe
the elements that must be addressed in establishing local
grievance procedures and provide grantees with flexibility in
the design of such local procedures.
``(B) Review.--The Secretary shall review grievance
procedures established by the planning council and grantees
under this part to determine if such procedures are adequate.
In making such a determination, the Secretary shall assess
whether such procedures permit legitimate grievances to be
filed, evaluated, and resolved at the local level.
``(2) Grantees.--To be eligible to receive funds under this
part, a grantee shall develop grievance procedures that are
determined by the Secretary to be consistent with the model
procedures developed under paragraph (1)(A). Such procedures shall
include a process for submitting grievances to binding
arbitration.''.
(2) Distribution of grants.--Section 2603 (42 U.S.C. 300ff-13)
is amended--
(A) in subsection (a)(2), by striking ``Not later than--''
and all that follows through ``the Secretary shall'' and
inserting the following: ``Not later than 60 days after an
appropriation becomes available to carry out this part for each
of the fiscal years 1996 through 2000, the Secretary shall'';
and
(B) in subsection (b)
(i) in paragraph (1)--
(I) by striking ``and'' at the end of subparagraph
(D);
(II) by striking the period at the end of
subparagraph (E) and inserting a semicolon; and
(III) by adding at the end thereof the following
new subparagraphs:
``(F) demonstrates the inclusiveness of the planning
council membership, with particular emphasis on affected
communities and individuals with HIV disease; and
``(G) demonstrates the manner in which the proposed
services are consistent with the local needs assessment and the
statewide coordinated statement of need.''; and
(ii) by redesignating paragraphs (2), (3), and (4) as
paragraphs (3), (4), and (5), respectively; and
(iii) by inserting after paragraph (1), the following
new paragraph:
``(2) Definition.--
``(A) Severe need.--In determining severe need in
accordance with paragraph (1)(B), the Secretary shall consider
the ability of the qualified applicant to expend funds
efficiently and the impact of relevant factors on the cost and
complexity of delivering health care and support services to
individuals with HIV disease in the eligible area, including
factors such as--
``(i) sexually transmitted diseases, substance abuse,
tuberculosis, severe mental illness, or other comorbid
factors determined relevant by the Secretary;
``(ii) new or growing subpopulations of individuals
with HIV disease; and
``(iii) homelessness.
``(B) Prevalence.--In determining the impact of the factors
described in subparagraph (A), the Secretary shall, to the
extent practicable, use national, quantitative incidence data
that are available for each eligible area. Not later than 2
years after the date of enactment of this paragraph, the
Secretary shall develop a mechanism to utilize such data. In
the absence of such data, the Secretary may consider a detailed
description and qualitative analysis of severe need, as
determined under subparagraph (A), including any local
prevalence data gathered and analyzed by the eligible area.
``(C) Priority.--Subsequent to the development of the
quantitative mechanism described in subparagraph (B), the
Secretary shall phase in, over a 3-year period beginning in
fiscal year 1998, the use of such a mechanism to determine the
severe need of an eligible area compared to other eligible
areas and to determine, in part, the amount of supplemental
funds awarded to the eligible area under this part.''.
(3) Distribution of funds.--
(A) In general.--Section 2603(a)(2) (42 U.S.C. 300ff-
13(a)(2)) (as amended by paragraph (2)) is further amended--
(i) by inserting ``, in accordance with paragraph (3)''
before the period; and
(ii) by adding at the end thereof the following new
sentences: ``The Secretary shall reserve an additional
percentage of the amount appropriated under section 2677
for a fiscal year for grants under part A to make grants to
eligible areas under section 2601(a) in accordance with
paragraph (4).''.
(B) Increase in grant.--Section 2603(a) (42 U.S.C. 300ff-
13(a)) is amended by adding at the end thereof the following
new paragraph:
``(4) Increase in grant.--With respect to an eligible area
under section 2601(a), the Secretary shall increase the amount of a
grant under paragraph (2) for a fiscal year to ensure that such
eligible area receives not less than--
``(A) with respect to fiscal year 1996, 100 percent;
``(B) with respect to fiscal year 1997, 99 percent;
``(C) with respect to fiscal year 1998, 98 percent;
``(D) with respect to fiscal year 1999, 96.5 percent; and
``(E) with respect to fiscal year 2000, 95 percent;
of the amount allocated for fiscal year 1995 to such entity under
this subsection.''.
(C) Additional requirements for grants.--Section 2603 (42
U.S.C. 300ff-13) is amended by adding at the end thereof the
following subsection:
``(c) Compliance With Priorities of HIV Planning Council.--
Notwithstanding any other provision of this part, the Secretary, in
carrying out section 2601(a), may not make any grant under subsection
(a) or (b) to an eligible area unless the application submitted by such
area under section 2605 for the grant involved demonstrates that the
grants made under subsections (a) and (b) to the area for the preceding
fiscal year (if any) were expended in accordance with the priorities
applicable to such year that were established, pursuant to section
2602(b)(3)(A), by the planning council serving the area.''.
(4) Use of amounts.--Section 2604 (42 U.S.C. 300ff-14) is
amended--
(A) in subsection (b)(1)(A)--
(i) by inserting ``, substance abuse treatment and
mental health treatment,'' after ``case management''; and
(ii) by inserting ``which shall include treatment
education and prophylactic treatment for opportunistic
infections,'' after ``treatment services,'';
(B) in subsection (b)(2)(A)--
(i) by inserting ``, or private for-profit entities if
such entities are the only available provider of quality
HIV care in the area,'' after ``nonprofit private
entities,''; and
(ii) by striking ``and homeless health centers'' and
inserting ``homeless health centers, substance abuse
treatment programs, and mental health programs'';
(C) by adding at the end of subsection (b), the following
new paragraph:
``(3) Priority for women, infants and children.--For the
purpose of providing health and support services to infants,
children, and women with HIV disease, including treatment measures
to prevent the perinatal transmission of HIV, the chief elected
official of an eligible area, in accordance with the established
priorities of the planning council, shall use, from the grants made
for the area under section 2601(a) for a fiscal year, not less than
the percentage constituted by the ratio of the population in such
area of infants, children, and women with acquired immune
deficiency syndrome to the general population in such area of
individuals with such syndrome.''; and
(C) in subsection (e)--
(i) in the subsection heading, by striking ``and
Planning;
(ii) by striking ``The chief'' and inserting:
``(1) In general.--The chief'';
(iii) by striking ``accounting, reporting, and program
oversight functions'';
(iv) by adding at the end thereof the following new
sentence: ``In the case of entities and subcontractors to
which such officer allocates amounts received by the
officer under the grant, the officer shall ensure that, of
the aggregate amount so allocated, the total of the
expenditures by such entities for administrative expenses
does not exceed 10 percent (without regard to whether
particular entities expend more than 10 percent for such
expenses).''; and
(v) by adding at the end thereof the following new
paragraphs:
``(2) Administrative activities.--For the purposes of paragraph
(1), amounts may be used for administrative activities that
include--
``(A) routine grant administration and monitoring
activities, including the development of applications for part
A funds, the receipt and disbursal of program funds, the
development and establishment of reimbursement and accounting
systems, the preparation of routine programmatic and financial
reports, and compliance with grant conditions and audit
requirements; and
``(B) all activities associated with the grantee's contract
award procedures, including the development of requests for
proposals, contract proposal review activities, negotiation and
awarding of contracts, monitoring of contracts through
telephone consultation, written documentation or onsite visits,
reporting on contracts, and funding reallocation activities.
``(3) Subcontractor administrative costs.--For the purposes of
this subsection, subcontractor administrative activities include--
``(A) usual and recognized overhead, including established
indirect rates for agencies;
``(B) management oversight of specific programs funded
under this title; and
``(C) other types of program support such as quality
assurance, quality control, and related activities.''.
(5) Application.--Section 2605 (42 U.S.C. 300ff-15) is
amended--
(A) in subsection (a)--
(i) in the matter preceding paragraph (1), by inserting
``, in accordance with subsection (c) regarding a single
application and grant award,'' after ``application'';
(ii) in paragraph (1)(B), by striking ``1-year period''
and all that follows through ``eligible area'' and
inserting ``preceding fiscal year'';
(iii) in paragraph (4), by striking ``and'' at the end
thereof;
(iv) in paragraph (5), by striking the period at the
end thereof and inserting ``; and''; and
(v) by adding at the end thereof the following new
paragraph:
``(6) that the applicant has participated, or will agree to
participate, in the statewide coordinated statement of need process
where it has been initiated by the State public health agency
responsible for administering grants under part B, and ensure that
the services provided under the comprehensive plan are consistent
with the statewide coordinated statement of need.'';
(B) in subsection (b)--
(i) in the subsection heading, by striking
``Additional''; and
(ii) in the matter preceding paragraph (1), by striking
``additional application'' and inserting ``application, in
accordance with subsection (c) regarding a single
application and grant award,''; and
(C) by redesignating subsections (c) and (d) as subsections
(d) and (e), respectively; and
(D) by inserting after subsection (b), the following new
subsection:
``(c) Single Application and Grant Award.--
``(1) Application.--The Secretary may phase in the use of a
single application that meets the requirements of subsections (a)
and (b) of section 2603 with respect to an eligible area that
desires to receive grants under section 2603 for a fiscal year.
``(2) Grant award.--The Secretary may phase in the awarding of
a single grant to an eligible area that submits an approved
application under paragraph (1) for a fiscal year.''.
(6) Technical assistance.--Section 2606 (42 U.S.C. 300ff-16) is
amended--
(A) by striking ``may'' and inserting ``shall'';
(B) by inserting after ``technical assistance'' the
following: ``, including assistance from other grantees,
contractors or subcontractors under this title to assist newly
eligible metropolitan areas in the establishment of HIV health
services planning councils and,''; and
(C) by adding at the end thereof the following new
sentences: ``The Administrator may make planning grants
available to metropolitan areas, in an amount not to exceed
$75,000 for any metropolitan area, projected to be eligible for
funding under section 2601 in the following fiscal year. Such
grant amounts shall be deducted from the first year formula
award to eligible areas accepting such grants. Not to exceed 1
percent of the amount appropriated for a fiscal year under
section 2677 for grants under part A may be used to carry out
this section.''.
(c) Care Grant Program.--
(1) Priority for women, infants and children.--Section 2611 (42
U.S.C. 300ff-21) is amended--
(A) by striking ``The'' and inserting ``(a) In General.--
The''; and
(B) by adding at the end thereof the following new
subsection:
``(b) Priority for Women, Infants and Children.--For the purpose of
providing health and support services to infants, children, and women
with HIV disease, including treatment measures to prevent the perinatal
transmission of HIV, a State shall use, of the funds allocated under
this part to the State for a fiscal year, not less than the percentage
constituted by the ratio of the population in the State of infants,
children, and women with acquired immune deficiency syndrome to the
general population in the State of individuals with such syndrome.''.
(2) Use of Grants.--Section 2612 (42 U.S.C. 300ff-22) is
amended--
(A) in subsection (a)--
(i) by striking the subsection designation and heading;
(ii) by redesignating paragraphs (1) through (4) as
paragraphs (2) through (5), respectively;
(iii) by inserting the following new paragraph:
``(1) to provide the services described in section 2604(b)(1)
for individuals with HIV disease;'';
(iv) in paragraph (5) (as so redesignated), by striking
``treatments'' and all that follows through ``health,'' and
inserting ``therapeutics to treat HIV disease''; and
(v) by adding at the end thereof the following flush
sentences:
``Services described in paragraph (1) shall be delivered through
consortia designed as described in paragraph (2), where such consortia
exist, unless the State demonstrates to the Secretary that delivery of
such services would be more effective when other delivery mechanisms
are used. In making a determination regarding the delivery of services,
the State shall consult with appropriate representatives of service
providers and recipients of services who would be affected by such
determination, and shall include in its demonstration to the Secretary
the findings of the State regarding such consultation.''; and
(B) by striking subsection (b).
(2) HIV care consortia.--Section 2613 (42 U.S.C. 300ff-23) is
amended--
(A) in subsection (a)--
(i) in paragraph (1), by inserting ``(or private for-
profit providers or organizations if such entities are the
only available providers of quality HIV care in the area)''
after ``nonprofit private,''; and
(ii) in paragraph (2)(A)--
(I) by inserting ``substance abuse treatment,
mental health treatment,'' after ``nursing,''; and
(II) by inserting ``prophylactic treatment for
opportunistic infections, treatment education to take
place in the context of health care delivery,'' after
``monitoring,''; and
(B) in subsection (c)--
(i) in subparagraph (C) of paragraph (1), by inserting
before ``care'' ``and youth centered''; and
(ii) in paragraph (2)--
(I) in clause (ii) of subparagraph (A), by striking
``served; and'' and inserting ``served;'';
(II) in subparagraph (B), by striking the period at
the end and inserting ``; and''; and
(III) by adding after subparagraph (B), the
following new subparagraph:
``(C) grantees under section 2671, or, if none are
operating in the area, representatives in the area of
organizations with a history of serving children, youth, women,
and families living with HIV.''.
(3) Provision of treatments.--Section 2616 (42 U.S.C. 300ff-26)
is amended--
(A) in subsection (a)--
(i) by striking ``may use amounts'' and inserting
``shall use a portion of the amounts'';
(ii) by striking ``section 2612(a)(4)'' and all that
follows through ``prolong life'' and inserting ``section
2612(a)(5) to provide therapeutics to treat HIV disease'';
and
(iii) by inserting before the period the following: ``,
including measures for the prevention and treatment of
opportunistic infections'';
(B) in subsection (c)--
(i) in paragraph (3), by striking ``and'' at the end
thereof;
(ii) in paragraph (4), by striking the period and
inserting ``; and''; and
(iii) by adding at the end thereof the following new
paragraph:
``(5) document the progress made in making therapeutics
described in subsection (a) available to individuals eligible for
assistance under this section.''; and
(C) by adding at the end thereof the following new
subsection:
``(d) Duties of the Secretary.--In carrying out this section, the
Secretary shall review the current status of State drug reimbursement
programs established under section 2612(2) and assess barriers to the
expanded availability of the treatments described in subsection (a).
The Secretary shall also examine the extent to which States coordinate
with other grantees under this title to reduce barriers to the expanded
availability of the treatments described in subsection (a).''.
(4) State application.--Section 2617(b) (42 U.S.C. 300ff-27(b))
is amended--
(A) in paragraph (2)--
(i) in subparagraph (A), by striking ``and'' at the end
thereof; and
(ii) by adding at the end thereof the following new
subparagraph:
``(C) a description of how the allocation and utilization
of resources are consistent with the statewide coordinated
statement of need (including traditionally underserved
populations and subpopulations) developed in partnership with
other grantees in the State that receive funding under this
title; and'';
(B) by redesignating paragraph (3) as paragraph (4);
(C) by inserting after paragraph (2), the following new
paragraph:
``(3) an assurance that the public health agency administering
the grant for the State will periodically convene a meeting of
individuals with HIV, representatives of grantees under each part
under this title, providers, and public agency representatives for
the purpose of developing a statewide coordinated statement of
need; and''.
(5) Planning, evaluation and administration.--Section 2618(c)
(42 U.S.C. 300ff-28(c)) is amended--
(A) by striking paragraph (1);
(B) in paragraphs (3) and (4), to read as follows:
``(3) Planning and evaluations.--Subject to paragraph (5) and
except as provided in paragraph (6), a State may not use more than
10 percent of amounts received under a grant awarded under this
part for planning and evaluation activities.
``(4) Administration.--
``(A) In general.--Subject to paragraph (5) and except as
provided in paragraph (6), a State may not use more than 10
percent of amounts received under a grant awarded under this
part for administration. In the case of entities and
subcontractors to which the State allocates amounts received by
the State under the grant (including consortia under section
2613), the State shall ensure that, of the aggregate amount so
allocated, the total of the expenditures by such entities for
administrative expenses does not exceed 10 percent (without
regard to whether particular entities expend more than 10
percent for such expenses).
``(B) Administrative activities.--For the purposes of
subparagraph (A), amounts may be used for administrative
activities that include routine grant administration and
monitoring activities.
``(C) Subcontractor administrative costs.--For the purposes
of this paragraph, subcontractor administrative activities
include--
``(i) usual and recognized overhead, including
established indirect rates for agencies;
``(ii) management oversight of specific programs funded
under this title; and
``(iii) other types of program support such as quality
assurance, quality control, and related activities.'';
(C) by redesignating paragraph (5) as paragraph (7); and
(D) by inserting after paragraph (4), the following new
paragraphs:
``(5) Limitation on use of funds.--Except as provided in
paragraph (6), a State may not use more than a total of 15 percent
of amounts received under a grant awarded under this part for the
purposes described in paragraphs (3) and (4).
``(6) Exception.--With respect to a State that receives the
minimum allotment under subsection (a)(1) for a fiscal year, such
State, from the amounts received under a grant awarded under this
part for such fiscal year for the activities described in
paragraphs (3) and (4), may, notwithstanding paragraphs (3), (4),
and (5), use not more than that amount required to support one
full-time-equivalent employee.''.
(6) Technical assistance.--Section 2619 (42 U.S.C. 300ff-29) is
amended--
(A) by striking ``may'' and inserting ``shall''; and
(B) by inserting before the period the following: ``,
including technical assistance for the development and
implementation of statewide coordinated statements of need''.
(7) Coordination.--Part B of title XXVI (42 U.S.C. 300ff-21 et
seq.) is amended by adding at the end thereof the following new
section:
``SEC. 2621. COORDINATION.
``The Secretary shall ensure that the Health Resources and Services
Administration, the Centers for Disease Control and Prevention, and the
Substance Abuse and Mental Health Services Administration coordinate
the planning and implementation of Federal HIV programs in order to
facilitate the local development of a complete continuum of HIV-related
services for individuals with HIV disease and those at risk of such
disease. Not later than October 1, 1996, and biennially thereafter, the
Secretary shall submit to the appropriate committees of the Congress a
report concerning coordination efforts under this title at the Federal,
State, and local levels, including a statement of whether and to what
extent there exist Federal barriers to integrating HIV-related
programs.''.
(d) Early Intervention Services.--
(1) Establishment of program.--Section 2651(b) (42 U.S.C.
300ff-51(b)) is amended--
(A) in paragraph (1), by inserting before the period the
following: ``, and unless the applicant agrees to expend not
less than 50 percent of the grant for such services that are
specified in subparagraphs (B) through (E) of such paragraph
for individuals with HIV disease''; and
(B) in paragraph (4)--
(i) by striking ``The Secretary'' and inserting ``(A)
In general.--The Secretary'';
(ii) by inserting ``, or private for-profit entities if
such entities are the only available provider of quality
HIV care in the area,'' after ``nonprofit private
entities'';
(iii) by realigning the margin of subparagraph (A) so
as to align with the margin of paragraph (3)(A); and
(iv) by adding at the end thereof the following new
subparagraph:
``(B) Other requirements.--Grantees described in--
``(i) paragraphs (1), (2), (5), and (6) of section
2652(a) shall use not less than 50 percent of the amount of
such a grant to provide the services described in
subparagraphs (A), (B), (D), and (E) of section 2651(b)(2)
directly and on-site or at sites where other primary care
services are rendered; and
``(ii) paragraphs (3) and (4) of section 2652(a) shall
ensure the availability of early intervention services
through a system of linkages to community-based primary
care providers, and to establish mechanisms for the
referrals described in section 2651(b)(2)(C), and for
follow-up concerning such referrals.''.
(2) Minimum qualifications.--Section 2652(b)(1)(B) (42 U.S.C.
300ff-52(b)(1)(B)) is amended by inserting ``, or a private for-
profit entity if such entity is the only available provider of
quality HIV care in the area,'' after ``nonprofit private entity''.
(3) Miscellaneous provisions.--Section 2654 (42 U.S.C. 300ff-
54) is amended by adding at the end thereof the following new
subsection:
``(c) Planning and Development Grants.--
``(1) In general.--The Secretary may provide planning grants,
in an amount not to exceed $50,000 for each such grant, to public
and nonprofit private entities for the purpose of enabling such
entities to provide HIV early intervention services.
``(2) Requirement.--The Secretary may only award a grant to an
entity under paragraph (1) if the Secretary determines that the
entity will use such grant to assist the entity in qualifying for a
grant under section 2651.
``(3) Preference.--In awarding grants under paragraph (1), the
Secretary shall give preference to entities that provide primary
care services in rural or underserved communities.
``(4) Limitation.--Not to exceed 1 percent of the amount
appropriated for a fiscal year under section 2655 may be used to
carry out this section.''.
(4) Authorization of appropriations.--Section 2655 (42 U.S.C.
300ff-55) is amended by striking ``$75,000,000'' and all that
follows through the end of the section, and inserting ``such sums
as may be necessary in each of the fiscal years 1996, 1997, 1998,
1999, and 2000.''.
(5) Required agreements.--Section 2664(g) (42 U.S.C. 300ff-
64(g)) is amended--
(A) in paragraph (2), by striking ``and'' at the end
thereof;
(B) in paragraph (3)--
(i) by striking ``5 percent'' and inserting ``7.5
percent including planning and evaluation''; and
(ii) by striking the period and inserting ``; and'';
and
(C) by adding at the end thereof the following new
paragraph:
``(4) the applicant will submit evidence that the proposed
program is consistent with the statewide coordinated statement of
need and agree to participate in the ongoing revision of such
statement of need.''.
(e) Demonstration Grants for Research and Services for Pediatric
Patients.--Section 2671 (42 U.S.C. 300f-71) is amended to read as
follows:
``SEC. 2671. GRANTS FOR COORDINATED SERVICES AND ACCESS TO RESEARCH FOR
WOMEN, INFANTS, CHILDREN, AND YOUTH.
``(a) In General.--The Secretary, acting through the Administrator
of the Health Resources and Services Administration and in consultation
with the Director of the National Institutes of Health, shall make
grants to public and nonprofit private entities that provide primary
care (directly or through contracts) for the following purposes:
``(1) Providing through such entities, in accordance with this
section, opportunities for women, infants, children, and youth to
be voluntary participants in research of potential clinical benefit
to individuals with HIV disease.
``(2) In the case of women, infants, children, and youth with
HIV disease, and the families of such individuals, providing to
such individuals--
``(A) health care on an outpatient basis; and
``(B) additional services in accordance with subsection
(d).
``(b) Provisions Regarding Participation in Research.--
``(1) In general.--With respect to the projects of research
with which an applicant under subsection (a) is concerned, the
Secretary may make a grant under such subsection to the applicant
only if the following conditions are met:
``(A) The applicant agrees to make reasonable efforts--
``(i) to identify which of the patients of the
applicant are women, infants, children, and youth who would
be appropriate participants in the projects;
``(ii) to carry out clause (i) through the use of
criteria provided for such purpose by the entities that
will be conducting the projects of research; and
``(iii) to offer women, infants, children, and youth
the opportunity to participate in the projects (as
appropriate), including the provision of services under
subsection (d)(3).
``(B) The applicant agrees that, in the case of the
research-related functions to be carried out by the applicant
pursuant to subsection (a)(1), the applicant will comply with
accepted standards that are applicable to such functions
(including accepted standards regarding informed consent and
other protections for human subjects).
``(C) For the first and second fiscal years for which
grants under subsection (a) are to be made to the applicant,
the applicant agrees that, not later than the end of the second
fiscal year of receiving such a grant, a significant number of
women, infants, children, and youth who are patients of the
applicant will be participating in the projects of research.
``(D) Except as provided in paragraph (3) (and paragraph
(4), as applicable), for the third and subsequent fiscal years
for which such grants are to be made to the applicant, the
Secretary has determined that a significant number of such
individuals are participating in the projects.
``(2) Prohibition.--Receipt of services by a patient shall not
be conditioned upon the consent of the patient to participate in
research.
``(3) Significant participation; consideration by secretary of
certain circumstances.--In administering the requirement of
paragraph (1)(D), the Secretary shall take into account
circumstances in which a grantee under subsection (a) is
temporarily unable to comply with the requirement for reasons
beyond the control of the grantee, and shall in such circumstances
provide to the grantee a reasonable period of opportunity in which
to reestablish compliance with the requirement.
``(4) Significant participation; temporary waiver for original
grantees.--
``(A) In general.--In the case of an applicant under
subsection (a) who received a grant under such subsection for
fiscal year 1995, the Secretary may, subject to subparagraph
(B), provide to the applicant a waiver of the requirement of
paragraph (1)(D) if the Secretary determines that the applicant
is making reasonable progress toward meeting the requirement.
``(B) Termination of authority for waivers.--The Secretary
may not provide any waiver under subparagraph (A) on or after
October 1, 1998. Any such waiver provided prior to such date
terminates on such date, or on such earlier date as the
Secretary may specify.
``(c) Provisions Regarding Conduct of Research.--
``(1) In general.--With respect to eligibility for a grant
under subsection (a):
``(A) A project of research for which subjects are sought
pursuant to such subsection may be conducted by the applicant
for the grant, or by an entity with which the applicant has
made arrangements for purposes of the grant. The grant may not
be expended for the conduct of any project of research, except
for such research-related functions as are appropriate for
providing opportunities under subsection (a)(1) (including the
functions specified in subsection (b)(1)).
``(B) The grant may be made only if the Secretary makes the
following determinations:
``(i) The applicant or other entity (as the case may be
under subparagraph (A)) is appropriately qualified to
conduct the project of research. An entity shall be
considered to be so qualified if any research protocol of
the entity has been recommended for funding under this Act
pursuant to technical and scientific peer review through
the National Institutes of Health.
``(ii) The project of research is being conducted in
accordance with a research protocol to which the Secretary
gives priority regarding the prevention or treatment of HIV
disease in women, infants, children, or youth, subject to
paragraph (2).
``(2) List of research protocols.--
``(A) In general.--From among the research protocols
described in paragraph (1)(B)(ii), the Secretary shall
establish a list of research protocols that are appropriate for
purposes of subsection (a)(1). Such list shall be established
only after consultation with public and private entities that
conduct such research, and with providers of services under
subsection (a) and recipients of such services.
``(B) Discretion of secretary.--The Secretary may authorize
the use, for purposes of subsection (a)(1), of a research
protocol that is not included on the list under subparagraph
(A). The Secretary may waive the requirement specified in
paragraph (1)(B)(ii) in such circumstances as the Secretary
determines to be appropriate.
``(d) Additional Services for Patients and Families.--A grant under
subsection (a) may be made only if the applicant for the grant agrees
as follows:
``(1) The applicant will provide for the case management of the
patient involved and the family of the patient.
``(2) The applicant will provide for the patient and the family
of the patient--
``(A) referrals for inpatient hospital services, treatment
for substance abuse, and mental health services; and
``(B) referrals for other social and support services, as
appropriate.
``(3) The applicant will provide the patient and the family of
the patient with such transportation, child care, and other
incidental services as may be necessary to enable the patient and
the family to participate in the program established by the
applicant pursuant to such subsection.
``(e) Coordination With Other Entities.--A grant under subsection
(a) may be made only if the applicant for the grant agrees as follows:
``(1) The applicant will coordinate activities under the grant
with other providers of health care services under this Act, and
under title V of the Social Security Act.
``(2) The applicant will participate in the statewide
coordinated statement of need under part B (where it has been
initiated by the public health agency responsible for administering
grants under part B) and in revisions of such statement.
``(f) Application.--A grant under subsection (a) may be made only
if an application for the grant is submitted to the Secretary and the
application is in such form, is made in such manner, and contains such
agreements, assurances, and information as the Secretary determines to
be necessary to carry out this section.
``(g) Coordination With National Institutes of Health.--The
Secretary shall develop and implement a plan that provides for the
coordination of the activities of the National Institutes of Health
with the activities carried out under this section. In carrying out the
preceding sentence, the Secretary shall ensure that projects of
research conducted or supported by such Institutes are made aware of
applicants and grantees under subsection (a), shall require that the
projects, as appropriate, enter into arrangements for purposes of such
subsection, and shall require that each project entering into such an
arrangement inform the applicant or grantee under such subsection of
the needs of the project for the participation of women, infants,
children, and youth.
``(h) Annual Review of Programs; Evaluations.--
``(1) Review regarding access to and participation in
programs.--With respect to a grant under subsection (a) for an
entity for a fiscal year, the Secretary shall, not later than 180
days after the end of the fiscal year, provide for the conduct and
completion of a review of the operation during the year of the
program carried out under such subsection by the entity. The
purpose of such review shall be the development of recommendations,
as appropriate, for improvements in the following:
``(A) Procedures used by the entity to allocate
opportunities and services under subsection (a) among patients
of the entity who are women, infants, children, or youth.
``(B) Other procedures or policies of the entity regarding
the participation of such individuals in such program.
``(2) Evaluations.--The Secretary shall, directly or through
contracts with public and private entities, provide for evaluations
of programs carried out pursuant to subsection (a).
``(i) Training and Technical Assistance.--Of the amounts
appropriated under subsection (j) for a fiscal year, the Secretary may
use not more than five percent to provide, directly or through
contracts with public and private entities (which may include grantees
under subsection (a)), training and technical assistance to assist
applicants and grantees under subsection (a) in complying with the
requirements of this section.
``(j) Authorization of Appropriations.--For the purpose of carrying
out this section, there are authorized to be appropriated such sums as
may be necessary for each of the fiscal years 1996 through 2000.''.
(f) Evaluations and Reports.--Section 2674 (42 U.S.C. 300ff-74) is
amended--
(1) in subsection (b)--
(A) in the matter preceding paragraph (1), by striking
``not later than 1 year'' and all that follows through
``title,'' and inserting the following: ``not later than
October 1, 1996,'';
(B) by striking paragraphs (1) through (3) and inserting
the following paragraph:
``(1) evaluating the programs carried out under this title;
and''; and
(C) by redesignating paragraph (4) as paragraph (2); and
(2) by adding at the end the following subsection:
``(d) Allocation of Funds.--The Secretary shall carry out this
section with amounts available under section 241. Such amounts are in
addition to any other amounts that are available to the Secretary for
such purpose.''.
(g) Demonstration and Training.--
(1) In general.--Title XXVI is amended by adding at the end,
the following new part:
``PART F--DEMONSTRATION AND TRAINING
``Subpart I--Special Projects of National Significance
``SEC. 2691. SPECIAL PROJECTS OF NATIONAL SIGNIFICANCE.
``(a) In General.--Of the amount appropriated under each of parts
A, B, C, and D of this title for each fiscal year, the Secretary shall
use the greater of $20,000,000 or 3 percent of such amount appropriated
under each such part, but not to exceed $25,000,000, to administer a
special projects of national significance program to award direct
grants to public and nonprofit private entities including community-
based organizations to fund special programs for the care and treatment
of individuals with HIV disease.
``(b) Grants.--The Secretary shall award grants under subsection
(a) based on--
``(1) the need to assess the effectiveness of a particular
model for the care and treatment of individuals with HIV disease;
``(2) the innovative nature of the proposed activity; and
``(3) the potential replicability of the proposed activity in
other similar localities or nationally.
``(c) Special Projects.--Special projects of national significance
shall include the development and assessment of innovative service
delivery models that are designed to--
``(1) address the needs of special populations;
``(2) assist in the development of essential community-based
service delivery infrastructure; and
``(3) ensure the ongoing availability of services for Native
American communities to enable such communities to care for Native
Americans with HIV disease.
``(d) Special Populations.--Special projects of national
significance may include the delivery of HIV health care and support
services to traditionally underserved populations including--
``(1) individuals and families with HIV disease living in rural
communities;
``(2) adolescents with HIV disease;
``(3) Indian individuals and families with HIV disease;
``(4) homeless individuals and families with HIV disease;
``(5) hemophiliacs with HIV disease; and
``(6) incarcerated individuals with HIV disease.
``(e) Service Development Grants.--Special projects of national
significance may include the development of model approaches to
delivering HIV care and support services including--
``(1) programs that support family-based care networks and
programs that build organizational capacity critical to the
delivery of care in minority communities;
``(2) programs designed to prepare AIDS service organizations
and grantees under this title for operation within the changing
health care environment; and
``(3) programs designed to integrate the delivery of mental
health and substance abuse treatment with HIV services.
``(f) Coordination.--The Secretary may not make a grant under this
section unless the applicant submits evidence that the proposed program
is consistent with the statewide coordinated statement of need, and the
applicant agrees to participate in the ongoing revision process of such
statement of need.
``(g) Replication.--The Secretary shall make information concerning
successful models developed under this part available to grantees under
this title for the purpose of coordination, replication, and
integration. To facilitate efforts under this subsection, the Secretary
may provide for peer-based technical assistance from grantees funded
under this part.''.
(2) Repeal.--Subsection (a) of section 2618 (42 U.S.C. 300ff-
28(a)) is repealed.
(h) HIV/AIDS Communities, Schools, Centers.--
(1) New part.--Part F of title XXVI (as added by subsection
(e)) is further amended by adding at the end, the following new
subpart:
``Subpart II--AIDS Education and Training Centers
``SEC. 2692. HIV/AIDS COMMUNITIES, SCHOOLS, AND CENTERS.''.
(2) Amendments.--Section 776 (42 U.S.C. 294n) is amended--
(A) by striking the section heading; and
(B) in subsection (a)(1)--
(i) by striking subparagraphs (B) and (C);
(ii) by redesignating subparagraphs (A) and (D) as
subparagraphs (B) and (C), respectively;
(iii) by inserting before subparagraph (B) (as so
redesignated) the following new subparagraph:
``(A) training health personnel, including practitioners in
title XXVI programs and other community providers, in the
diagnosis, treatment, and prevention of HIV infection and
disease, including the prevention of the perinatal transmission
of the disease and including measures for the prevention and
treatment of opportunistic infections;''; and
(iv) in subparagraph (B) (as so redesignated) by adding
``and'' after the semicolon.
(3) Transfer.--Section 776 (42 U.S.C. 294n) (as amended by
paragraph (2)) is amended by transferring such section to section
2692 (as added by paragraph (1)).
(4) Authorization of appropriations.--Section 2692 (as added by
paragraph (1)) is amended by adding at the end thereof the
following new subsection:
``(d) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section, such sums as may be necessary
for each of the fiscal years 1996 through 2000.''.
SEC. 4. AMOUNT OF EMERGENCY RELIEF GRANTS.
Paragraph (3) of section 2603(a) (42 U.S.C. 300ff-13(a)(3)) is
amended to read as follows:
``(3) Amount of grant.--
``(A) In general.--Subject to the extent of amounts made
available in appropriations Acts, a grant made for purposes of
this paragraph to an eligible area shall be made in an amount
equal to the product of--
``(i) an amount equal to the amount available for
distribution under paragraph (2) for the fiscal year
involved; and
``(ii) the percentage constituted by the ratio of the
distribution factor for the eligible area to the sum of the
respective distribution factors for all eligible areas.
``(B) Distribution factor.--For purposes of subparagraph
(A)(ii), the term `distribution factor' means an amount equal
to the estimated number of living cases of acquired immune
deficiency syndrome in the eligible area involved, as
determined under subparagraph (C).
``(C) Estimate of living cases.--The amount determined in
this subparagraph is an amount equal to the product of--
``(i) the number of cases of acquired immune deficiency
syndrome in the eligible area during each year in the most
recent 120-month period for which data are available with
respect to all eligible areas, as indicated by the number
of such cases reported to and confirmed by the Director of
the Centers for Disease Control and Prevention for each
year during such period; and
``(ii) with respect to--
``(I) the first year during such period, .06;
``(II) the second year during such period, .06;
``(III) the third year during such period, .08;
``(IV) the fourth year during such period, .10;
``(V) the fifth year during such period, .16;
``(VI) the sixth year during such period, .16;
``(VII) the seventh year during such period, .24;
``(VIII) the eighth year during such period, .40;
``(IX) the ninth year during such period, .57; and
``(X) the tenth year during such period, .88.
The yearly percentage described in subparagraph (ii) shall be
updated biennially by the Secretary, after consultation with
the Centers for Disease Control and Prevention. The first such
update shall occur prior to the determination of grant awards
under this part for fiscal year 1998.
``(D) Unexpended funds.--The Secretary may, in determining
the amount of a grant for a fiscal year under this paragraph,
adjust the grant amount to reflect the amount of unexpended and
uncanceled grant funds remaining at the end of the fiscal year
preceding the year for which the grant determination is to be
made. The amount of any such unexpended funds shall be
determined using the financial status report of the grantee.''.
SEC. 5. AMOUNT OF CARE GRANTS.
Paragraphs (1) and (2) of section 2618(b) (42 U.S.C. 300ff-28(b)
(1) and (2)) are amended to read as follows:
``(1) Minimum allotment.--Subject to the extent of amounts made
available under section 2677, the amount of a grant to be made
under this part for--
``(A) each of the several States and the District of
Columbia for a fiscal year shall be the greater of--
``(i)(I) with respect to a State or District that has
less than 90 living cases of acquired immune deficiency
syndrome, as determined under paragraph (2)(D), $100,000;
or
``(II) with respect to a State or District that has 90
or more living cases of acquired immune deficiency
syndrome, as determined under paragraph (2)(D), $250,000;
``(ii) an amount determined under paragraph (2); and
``(B) each territory of the United States, as defined in
paragraph (3), shall be an amount determined under paragraph
(2).
``(2) Determination.--
``(A) Formula.--The amount referred to in paragraph
(1)(A)(ii) for a State and paragraph (1)(B) for a territory of
the United States shall be the product of--
``(i) an amount equal to the amount appropriated under
section 2677 for the fiscal year involved for grants under
part B, subject to subparagraph (H); and
``(ii) the percentage constituted by the sum of--
``(I) the product of .80 and the ratio of the State
distribution factor for the State or territory (as
determined under subsection (B)) to the sum of the
respective State distribution factors for all States or
territories; and
``(II) the product of .20 and the ratio of the non-
EMA distribution factor for the State or territory (as
determined under subparagraph (C)) to the sum of the
respective distribution factors for all States or
territories.
``(B) State distribution factor.--For purposes of
subparagraph (A)(ii)(I), the term `State distribution factor'
means an amount equal to the estimated number of living cases
of acquired immune deficiency syndrome in the eligible area
involved, as determined under subparagraph (D).
``(C) Non-ema distribution factor.--For purposes of
subparagraph (A)(ii)(II), the term `non-ema distribution
factor' means an amount equal to the sum of--
``(i) the estimated number of living cases of acquired
immune deficiency syndrome in the State or territory
involved, as determined under subparagraph (D); less
``(ii) the estimated number of living cases of acquired
immune deficiency syndrome in such State or territory that
are within an eligible area (as determined under part A).
``(D) Estimate of living cases.--The amount determined in
this subparagraph is an amount equal to the product of--
``(i) the number of cases of acquired immune deficiency
syndrome in the State or territory during each year in the
most recent 120-month period for which data are available
with respect to all States and territories, as indicated by
the number of such cases reported to and confirmed by the
Director of the Centers for Disease Control and Prevention
for each year during such period; and
``(ii) with respect to each of the first through the
tenth year during such period, the amount referred to in
section 2603(a)(3)(C)(ii).
``(E) Puerto rico, virgin islands, guam.--For purposes of
subparagraph (D), the cost index for Puerto Rico, the Virgin
Islands, and Guam shall be 1.0.
``(F) Unexpended funds.--The Secretary may, in determining
the amount of a grant for a fiscal year under this subsection,
adjust the grant amount to reflect the amount of unexpended and
uncanceled grant funds remaining at the end of the fiscal year
preceding the year for which the grant determination is to be
made. The amount of any such unexpended funds shall be
determined using the financial status report of the grantee.
``(G) Limitation.--
``(i) In general.--The Secretary shall ensure that the
amount of a grant awarded to a State or territory for a
fiscal year under this part is equal to not less than--
``(I) with respect to fiscal year 1996, 100
percent;
``(II) with respect to fiscal year 1997, 99
percent;
``(III) with respect to fiscal year 1998, 98
percent;
``(IV) with respect to fiscal year 1999, 96.5
percent; and
``(V) with respect to fiscal year 2000, 95 percent;
of the amount such State or territory received for fiscal
year 1995 under this part. In administering this
subparagraph, the Secretary shall, with respect to States
that will receive grants in amounts that exceed the amounts
that such States received under this part in fiscal year
1995, proportionally reduce such amounts to ensure
compliance with this subparagraph. In making such
reductions, the Secretary shall ensure that no such State
receives less than that State received for fiscal year
1995.
``(ii) Ratable reduction.--If the amount appropriated
under section 2677 and available for allocation under this
part is less than the amount appropriated and available
under this part for fiscal year 1995, the limitation
contained in clause (i) shall be reduced by a percentage
equal to the percentage of the reduction in such amounts
appropriated and available.
``(H) Appropriations for treatment drug program.--With
respect to the fiscal year involved, if under section 2677 an
appropriations Act provides an amount exclusively for carrying
out section 2616, the portion of such amount allocated to a
State shall be the product of--
``(i) 100 percent of such amount; and
``(ii) the percentage constituted by the ratio of the
State distribution factor for the State (as determined
under subparagraph (B)) to the sum of the State
distribution factors for all States.''.
SEC. 6. CONSOLIDATION OF AUTHORIZATIONS OF APPROPRIATIONS.
(a) In General.--Part D of title XXVI (42 U.S.C. 300ff-71) is
amended by adding at the end thereof the following new section:
``SEC. 2677. AUTHORIZATION OF APPROPRIATIONS.
``(a) In General.--Subject to subsection (b), there are authorized
to be appropriated to make grants under parts A and B, such sums as may
be necessary for each of the fiscal years 1996 through 2000.
``(b) Development of Methodology.--
``(1) In general.--With respect to each of the fiscal years
1997 through 2000, the Secretary shall develop and implement a
methodology for adjusting the percentages allocated to part A and
part B to account for grants to new eligible areas under part A and
other relevant factors. Not later than July 1, 1996, the Secretary
shall prepare and submit to the appropriate committees of Congress
a report regarding the findings with respect to the methodology
developed under this paragraph.
``(2) Failure to implement.--If the Secretary determines that
such a methodology under paragraph (1) cannot be developed, there
are authorized to be appropriated--
``(A) such sums as may be necessary to carry out part A for
each of the fiscal years 1997 through 2000; and
``(B) such sums as may be necessary to carry out part B for
each of the fiscal years 1997 through 2000.''.
(b) Repeals.--Sections 2608 and 2620 (42 U.S.C. 300ff-18 and 300ff-
30) are repealed.
(c) Conforming Amendments.--Title XXVI is amended--
(1) in section 2603 (42 U.S.C. 300ff-13)--
(A) in subsection (a)(2), by striking ``2608'' and
inserting ``2677''; and
(B) in subsection (b)(1), by striking ``2608'' and
inserting ``2677'';
(2) in section 2605(c)(1) (42 U.S.C. 300ff-15(c)(1)) is amended
by striking ``2608'' and inserting ``2677''; and
(3) in section 2618 (42 U.S.C. 300ff-28)--
(A) in subsection (a)(1), is amended by striking ``2620''
and inserting ``2677''; and
(B) in subsection (b)(1), is amended by striking ``2620''
and inserting ``2677''.
SEC. 7. PERINATAL TRANSMISSION OF HIV DISEASE.
(a) Findings.--The Congress finds as follows:
(1) Research studies and statewide clinical experiences have
demonstrated that administration of anti-retroviral medication
during pregnancy can significantly reduce the transmission of the
human immunodeficiency virus (commonly known as HIV) from an
infected mother to her baby.
(2) The Centers for Disease Control and Prevention have
recommended that all pregnant women receive HIV counseling;
voluntary, confidential HIV testing; and appropriate medical
treatment (including anti-retroviral therapy) and support services.
(3) The provision of such testing without access to such
counseling, treatment, and services will not improve the health of
the woman or the child.
(4) The provision of such counseling, testing, treatment, and
services can reduce the number of pediatric cases of acquired
immune deficiency syndrome, can improve access to and provision of
medical care for the woman, and can provide opportunities for
counseling to reduce transmission among adults, and from mother to
child.
(5) The provision of such counseling, testing, treatment, and
services can reduce the overall cost of pediatric cases of acquired
immune deficiency syndrome.
(6) The cancellation or limitation of health insurance or other
health coverage on the basis of HIV status should be impermissible
under applicable law. Such cancellation or limitation could result
in disincentives for appropriate counseling, testing, treatment,
and services.
(7) For the reasons specified in paragraphs (1) through (6)--
(A) routine HIV counseling and voluntary testing of
pregnant women should become the standard of care; and
(B) the relevant medical organizations as well as public
health officials should issue guidelines making such counseling
and testing the standard of care.
(b) Additional Requirements for Grants.--Part B of title XXVI (42
U.S.C. 300ff-21 et seq.) is amended--
(1) by inserting after the part heading the following:
``Subpart I--General Grant Provisions'';
(2) in section 2611(a), by adding at the end the following
sentence: ``The authority of the Secretary to provide grants under
part B is subject to section 2626(e)(2) (relating to the decrease
in perinatal transmission of HIV disease).''; and
(3) by adding at the end thereof the following new subpart:
``Subpart II--Provisions Concerning Pregnancy and Perinatal
Transmission of HIV
``SEC. 2625. CDC GUIDELINES FOR PREGNANT WOMEN.
``(a) Requirement.--Notwithstanding any other provision of law, a
State shall, not later than 120 days after the date of enactment of
this subpart, certify to the Secretary that such State has in effect
regulations or measures to adopt the guidelines issued by the Centers
for Disease Control and Prevention concerning recommendations for human
immunodeficiency virus counseling and voluntary testing for pregnant
women.
``(b) Noncompliance.--If a State does not provide the certification
required under subsection (a) within the 120-day period described in
such subsection, such State shall not be eligible to receive assistance
for HIV counseling and testing under this section until such
certification is provided.
``(c) Additional Funds Regarding Women and Infants.--
``(1) In general.--If a State provides the certification
required in subsection (a) and is receiving funds under part B for
a fiscal year, the Secretary may (from the amounts available
pursuant to paragraph (2)) make a grant to the State for the fiscal
year for the following purposes:
``(A) Making available to pregnant women appropriate
counseling on HIV disease.
``(B) Making available outreach efforts to pregnant women
at high risk of HIV who are not currently receiving prenatal
care.
``(C) Making available to such women voluntary HIV testing
for such disease.
``(D) Offsetting other State costs associated with the
implementation of this section and subsections (a) and (b) of
section 2626.
``(E) Offsetting State costs associated with the
implementation of mandatory newborn testing in accordance with
this title or at an earlier date than is required by this
title.
``(2) Funding.--For purposes of carrying out this subsection,
there are authorized to be appropriated $10,000,000 for each of the
fiscal years 1996 through 2000. Amounts made available under
section 2677 for carrying out this part are not available for
carrying out this section unless otherwise authorized.
``(3) Priority.--In awarding grants under this subsection the
Secretary shall give priority to States that have the greatest
proportion of HIV seroprevalance among child bearing women using
the most recent data available as determined by the Centers for
Disease Control and Prevention.
``SEC. 2626. PERINATAL TRANSMISSION OF HIV DISEASE; CONTINGENT
REQUIREMENT REGARDING STATE GRANTS UNDER THIS PART.
``(a) Annual Determination of Reported Cases.--A State shall
annually determine the rate of reported cases of AIDS as a result of
perinatal transmission among residents of the State.
``(b) Causes of Perinatal Transmission.--In determining the rate
under subsection (a), a State shall also determine the possible causes
of perinatal transmission. Such causes may include--
``(1) the inadequate provision within the State of prenatal
counseling and testing in accordance with the guidelines issued by
the Centers for Disease Control and Prevention;
``(2) the inadequate provision or utilization within the State
of appropriate therapy or failure of such therapy to reduce
perinatal transmission of HIV, including--
``(A) that therapy is not available, accessible or offered
to mothers; or
``(B) that available therapy is offered but not accepted by
mothers; or
``(3) other factors (which may include the lack of prenatal
care) determined relevant by the State.
``(c) CDC Reporting System.--Not later than 4 months after the date
of enactment of this subpart, the Director of the Centers for Disease
Control and Prevention shall develop and implement a system to be used
by States to comply with the requirements of subsections (a) and (b).
The Director shall issue guidelines to ensure that the data collected
is statistically valid.
``(d) Determination by Secretary.--Not later than 180 days after
the expiration of the 18-month period beginning on the date on which
the system is implemented under subsection (c), the Secretary shall
publish in the Federal Register a determination of whether it has
become a routine practice in the provision of health care in the United
States to carry out each of the activities described in paragraphs (1)
through (5) of section 2627. In making the determination, the Secretary
shall consult with the States and with other public or private entities
that have knowledge or expertise relevant to the determination.
``(e) Contingent Applicability.--
``(1) In general.--If the determination published in the
Federal Register under subsection (d) is that (for purposes of such
subsection) the activities involved have become routine practices,
paragraph (2) shall apply on and after the expiration of the 18-
month period beginning on the date on which the determination is so
published.
``(2) Requirement.--Subject to subsection (f), the Secretary
shall not make a grant under part B to a State unless the State
meets not less than one of the following requirements:
``(A) A 50 percent reduction (or a comparable measure for
States with less than 10 cases) in the rate of new cases of
AIDS (recognizing that AIDS is a suboptimal proxy for tracking
HIV in infants and was selected because such data is
universally available) as a result of perinatal transmission as
compared to the rate of such cases reported in 1993 (a State
may use HIV data if such data is available).
``(B) At least 95 percent of women in the State who have
received at least two prenatal visits (consultations) prior to
34 weeks gestation with a health care provider or provider
group have been tested for the human immunodeficiency virus.
``(C) The State has in effect, in statute or through
regulations, the requirements specified in paragraphs (1)
through (5) of section 2627.
``(f) Limitation Regarding Availability of Funds.--With respect to
an activity described in any of paragraphs (1) through (5) of section
2627, the requirements established by a State under this section apply
for purposes of this section only to the extent that the following
sources of funds are available for carrying out the activity:
``(1) Federal funds provided to the State in grants under part
B or under section 2625, or through other Federal sources under
which payments for routine HIV testing, counseling or treatment are
an eligible use.
``(2) Funds that the State or private entities have elected to
provide, including through entering into contracts under which
health benefits are provided. This section does not require any
entity to expend non-Federal funds.
``SEC. 2627. TESTING OF PREGNANT WOMEN AND NEWBORN INFANTS.
``An activity or requirement described in this section is any of
the following:
``(1) In the case of newborn infants who are born in the State
and whose biological mothers have not undergone prenatal testing
for HIV disease, that each such infant undergo testing for such
disease.
``(2) That the results of such testing of a newborn infant be
promptly disclosed in accordance with the following, as applicable
to the infant involved:
``(A) To the biological mother of the infant (without
regard to whether she is the legal guardian of the infant).
``(B) If the State is the legal guardian of the infant:
``(i) To the appropriate official of the State agency
with responsibility for the care of the infant.
``(ii) To the appropriate official of each authorized
agency providing assistance in the placement of the infant.
``(iii) If the authorized agency is giving significant
consideration to approving an individual as a foster parent
of the infant, to the prospective foster parent.
``(iv) If the authorized agency is giving significant
consideration to approving an individual as an adoptive
parent of the infant, to the prospective adoptive parent.
``(C) If neither the biological mother nor the State is the
legal guardian of the infant, to another legal guardian of the
infant.
``(D) To the child's health care provider.
``(3) That, in the case of prenatal testing for HIV disease
that is conducted in the State, the results of such testing be
promptly disclosed to the pregnant woman involved.
``(4) That, in disclosing the test results to an individual
under paragraph (2) or (3), appropriate counseling on the human
immunodeficiency virus be made available to the individual (except
in the case of a disclosure to an official of a State or an
authorized agency).
``(5) With respect to State insurance laws, that such laws
require--
``(A) that, if health insurance is in effect for an
individual, the insurer involved may not (without the consent
of the individual) discontinue the insurance, or alter the
terms of the insurance (except as provided in subparagraph
(C)), solely on the basis that the individual is infected with
HIV disease or solely on the basis that the individual has been
tested for the disease or its manifestation;
``(B) that subparagraph (A) does not apply to an individual
who, in applying for the health insurance involved, knowingly
misrepresented the HIV status of the individual; and
``(C) that subparagraph (A) does not apply to any
reasonable alteration in the terms of health insurance for an
individual with HIV disease that would have been made if the
individual had a serious disease other than HIV disease.
For purposes of this subparagraph, a statute or regulation shall be
deemed to regulate insurance for purposes of this paragraph only to
the extent that such statute or regulation is treated as regulating
insurance for purposes of section 514(b)(2) of the Employee
Retirement Income Security Act of 1974.
``SEC. 2628. REPORT BY THE INSTITUTE OF MEDICINE.
``(a) In General.--The Secretary shall request that the Institute
of Medicine of the National Academy of Sciences conduct an evaluation
of the extent to which State efforts have been effective in reducing
the perinatal transmission of the human immuno deficiency virus, and an
analysis of the existing barriers to the further reduction in such
transmission.
``(b) Report to Congress.--The Secretary shall ensure that, not
later than 2 years after the date of enactment of this section, the
evaluation and analysis described in subsection (a) is completed and a
report summarizing the results of such evaluation and analysis is
prepared by the Institute of Medicine and submitted to the appropriate
committees of Congress together with the recommendations of the
Institute.
``SEC. 2629. STATE HIV TESTING PROGRAMS ESTABLISHED PRIOR TO OR AFTER
ENACTMENT.
``Nothing in this subpart shall be construed to disqualify a State
from receiving grants under this title if such State has established at
any time prior to or after the date of enactment of this subpart a
program of mandatory HIV testing.''.
SEC. 8. SPOUSAL NOTIFICATION.
(a) In General.--The Secretary of Health and Human Services shall
not make a grant under part B of title XXVI of the Public Health
Service Act (42 U.S.C. 300ff-21 et seq.) to any State unless such State
takes administrative or legislative action to require that a good faith
effort be made to notify a spouse of a known HIV-infected patient that
such spouse may have been exposed to the human immunodeficiency virus
and should seek testing.
(b) Definitions.--For purposes of this section:
(1) Spouse.--The term ``spouse'' means any individual who is
the marriage partner of an HIV-infected patient, or who has been
the marriage partner of that patient at any time within the 10-year
period prior to the diagnosis of HIV infection.
(2) HIV-infected patient.--The term ``HIV-infected patient''
means any individual who has been diagnosed to be infected with the
human immunodeficiency virus.
(3) State.--The term ``State'' means any of the 50 States, the
District of Columbia, or any territory of the United States.
SEC. 9. OPTIONAL PARTICIPATION OF FEDERAL EMPLOYEES IN AIDS TRAINING
PROGRAMS.
(a) In General.--Notwithstanding any other provision of law, a
Federal employee may not be required to attend or participate in an
AIDS or HIV training program if such employee refuses to consent to
such attendance or participation, except for training necessary to
protect the health and safety of the Federal employee and the
individuals served by such employees. An employer may not retaliate in
any manner against such an employee because of the refusal of such
employee to consent to such attendance or participation.
(b) Definition.--As used in subsection (a), the term ``Federal
employee'' has the same meaning given the term ``employee'' in section
2105 of title 5, United States Code, and such term shall include
members of the armed forces.
SEC. 10. PROHIBITION ON PROMOTION OF CERTAIN ACTIVITIES.
Part D of title XXVI of the Public Health Service Act (42 U.S.C.
300ff-71) as amended by section 6, is further amended by adding at the
end thereof the following new section:
``SEC. 2678. PROHIBITION ON PROMOTION OF CERTAIN ACTIVITIES.
``None of the funds authorized under this title shall be used to
fund AIDS programs, or to develop materials, designed to promote or
encourage, directly, intravenous drug use or sexual activity, whether
homosexual or heterosexual. Funds authorized under this title may be
used to provide medical treatment and support services for individuals
with HIV.''.
SEC. 11. LIMITATION ON APPROPRIATIONS.
Notwithstanding any other provision of law, the total amounts of
Federal funds expended in any fiscal year for AIDS and HIV activities
may not exceed the total amounts expended in such fiscal year for
activities related to cancer.
SEC. 12. ADDITIONAL PROVISIONS.
(a) Definitions.--Section 2676(4) (42 U.S.C. 300ff-76(4)) is
amended by inserting ``funeral-service practitioners,'' after
``emergency medical technicians,''.
(b) Miscellaneous Amendment.--Section 1201(a) (42 U.S.C. 300d(a))
is amended in the matter preceding paragraph (1) by striking ``The
Secretary,'' and all that follows through ``shall,'' and inserting
``The Secretary shall,''.
(c) Technical Corrections.--Title XXVI (42 U.S.C. 300ff-11 et seq.)
is amended--
(1) in section 2601(a), by inserting ``section'' before
``2604'';
(2) in section 2603(b)(4)(B), by striking ``an expedited
grants'' and inserting ``an expedited grant'';
(3) in section 2617(b)(3)(B)(iv), by inserting ``section''
before ``2615'';
(4) in section 2647--
(A) in subsection (a)(1), by inserting ``to'' before
``HIV'';
(B) in subsection (c), by striking ``section 2601'' and
inserting ``section 2641''; and
(C) in subsection (d)--
(i) in the matter preceding paragraph (1), by striking
``section 2601'' and inserting ``section 2641''; and
(ii) in paragraph (1), by striking ``has in place'' and
inserting ``will have in place'';
(5) in section 2648--
(A) by converting the heading for the section to boldface
type; and
(B) by redesignating the second subsection (g) as
subsection (h);
(6) in section 2649--
(A) in subsection (b)(1), by striking ``subsection (a)
of''; and
(B) in subsection (c)(1), by striking ``this subsection''
and inserting ``subsection'';
(7) in section 2651--
(A) in subsection (b)(3)(B), by striking ``facility'' and
inserting ``facilities''; and
(B) in subsection (c), by striking ``exist'' and inserting
``exists'';
(8) in section 2676--
(A) in paragraph (2), by striking ``section'' and all that
follows through ``by the'' and inserting ``section 2686 by
the''; and
(B) in paragraph (10), by striking ``673(a)'' and inserting
``673(2)'';
(9) in part E, by converting the headings for subparts I and II
to Roman typeface; and
(10) in section 2684(b), in the matter preceding paragraph (1),
by striking ``section 2682(d)(2)'' and inserting ``section
2683(d)(2)''.
SEC. 13. EFFECTIVE DATE.
(a) In General.--Except as provided in subsection (b), this Act,
and the amendments made by this Act, shall become effective on October
1, 1996.
(b) Exception.--The amendments made by sections 3(a), 5, 6, and 7
of this Act to sections 2601(c), 2601(d), 2603(a), 2618(b), 2626, 2677,
and 2691 of the Public Health Service Act, shall become effective on
the date of enactment of this Act.
Speaker of the House of Representatives.
Vice President of the United States and
President of the Senate.